3307:1-11-11 Health care assistance.

(A) As used in this rule:

(1) "Earnings" shall mean the total of all job-related income, pension, disability and survivor benefits received, including any portion of a benefit or increase for which a written notice of waiver has been filed with the retirement board pursuant to section 3307.44 of the Revised Code, with the public employees retirement board pursuant to section 145.562 of the Revised Code or with the school employees retirement board pursuant to section 3307.662 of the Revised Code, social security payments, welfare benefits, workers' compensation benefits, child or spousal support, unemployment benefits, investment income and all reportable income according to the Internal Revenue Code of 1986.

(2) "Low-income earnings threshold" as used in this rule shall be equal to the minimum salary for a teacher with a bachelor's degree and five years experience as defined in section 3317.13 of the Revised Code, provided that in the event an individual experiences a life event once a calendar year has begun, such amounts shall be determined on a prorated basis as of the date the life event took place.

(3) "Liquid assets" shall include cash and all monies readily available to a family unit in savings accounts, checking accounts, money market accounts, trust funds, any publicly traded security or other investment vehicles as the board may from time to time specify.

(4) "Family unit" shall include the qualifying enrollee, spouse and children as defined in paragraph (B)(1) of rule 3307:1-11-01 of the Administrative Code.

(5) "Qualifying enrollee" shall include persons who:

(a) Were:

(i) Granted service retirement under sections 3307.50 to 3307.79 of the Revised Code with at least twenty-five years of total service credit at retirement that is not service credit excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

(ii) Granted disability benefits under sections 3307.50 to 3307.79 of the Revised Code, or

(iii) Beneficiaries of retired teachers with at least twenty-five years of total service credit at retirement and none of the service credit is excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

(iv) Survivors of either active teachers or disabled teachers eligible to retire with at least twenty-five years of total service credit at retirement and none of the service credit is excluded from premium waiver under the terms of paragraph (A)(3)(c) of rule 3307:1-11-03 of the Administrative Code or service credit purchased under section 3307.741 of the Revised Code; or

(v) Survivors of either active teachers or disabled teachers not eligible for service retirement; and

(b) Had annual earnings not greater than the low-income earnings threshold for the family unit of the person described in paragraph (A)(5)(a) of this rule and

(c) Had total liquid assets that did not exceed twenty-three thousand eight hundred dollars for the family unit of the person described in paragraph (A)(4)(a) of this rule.

(6) "Life event" includes the death of a spouse, divorce, loss of job or other events as the board may from time to time specify.

(7) "Minimum monthly health care premium" shall mean the lowest monthly premium charged any member for any group medical health care plan offered by the state teachers retirement system.

(B) A qualified enrollee may make application for health care assistance on a form provided by the retirement system. The effective date of the participation in the health care assistance program shall be the first of the month following the approval of the application. All applications for assistance must be received no later than the fifteenth of the month to be considered for approval for an effective date starting the next month.

(1) Each applicant shall demonstrate eligibility by providing the information specified on the form, which shall include copies of any federal tax return for the applicant, the spouse and any dependent children necessary to validate the earnings reported on an application and shall also include verification of medicare enrollment if applicable.

(2) An application of an individual who fails to supply all requested information within three months of filing shall be canceled.

(C) A qualified enrollee receiving health care assistance must annually verify continuing eligibility on a form provided by the retirement system to continue participation in the program. Failure to file the form or supply all requested information shall result in the individual no longer qualifying for the program and all assistance benefits shall be terminated.

(D) On and after July 1, 2004 and provided that the retirement board has not acted to terminate the health care assistance program hereby created, enrollees whose applications are granted under this rule shall qualify for:

(1) A minimum monthly health care premium in a health plan offered by the retirement system, and

(2) Health assistance plan benefits as determined by the board through certain health plans offered by the state teachers retirement system.

(3) A "qualifying enrollee" may elect to accept only the minimum health care premium and forego the health assistance plan benefits.

(4) The minimum monthly health care premium will not be in effect for any period the qualifying enrollee fails to provide verification of the individual's medicare enrollment.

(E) For qualifying enrollees making application for health care assistance at the same time application for service retirement or disability benefits are made, the benefits described in paragraph (D) of this rule shall take affect the first of the month following the approval of the health care assistance application or the first of the month after the monthly benefit amount is finalized, whichever is later. All applications for assistance must be received no later than the fifteenth of the month to be considered for approval for an effective date starting the next month.

(F) Assistance under this rule granted as the result of false information submitted on an application shall be terminated immediately. Any person who submits false or misleading information in connection with an application shall immediately repay the amounts of any assistance provided to date. If such amounts remain unpaid, they shall be deducted from any future amounts payable under Chapter 3307.. of the Revised Code.

Effective: 05/14/2009
R.C. 119.032 review dates: 02/26/2009 and 05/14/2014
Promulgated Under: 111.15
Statutory Authority: 3307.04
Rule Amplifies: 3307.39 , 3307.61
Prior Effective Dates: 7/1/04 (Emer.), 8/26/04, 7/1/07 (Emer.), 9/24/07